Effective communication between patients and healthcare professionals is essential to achieve positive clinical outcomes. Patients who are unable to communicate effectively (e.g., patients with limited English proficiency (LEP), those who are hearing-impaired, aphasic, or have oral/tracheal intubation) experience extreme frustration, panic, anxiety, sleeplessness, fear, frustration, isolation and insecurity when attempting to communicate. For more than 25 years, communications boards have been used to assist patients with communicating their needs when they cannot speak or write. Vidatak previously developed the EZ Board(tm) as a manual aide that in published studies has shown some value in helping mechanically ventilated (MV) patients communicate more effectively. Despite these advances, as well as multiple studies validating the EZ Board as the preferred intervention by patients and nurses, the EZ Board(tm) still has many shortcomings, which likely reduces impact and standardization in practice. This proposed STTR project will overcome most of these limitations by developing a digital tool with iPad and android technology, VidaTalk, which meets the usability requirements of a broad range of critically ill patients. The goal of thi STTR is to commercialize a comprehensive, versatile, and technologically integrated digital communication application that will meet the communication needs of MV patients, including patients with LEP, and will achieve effective communication for critically ill patients and thereby impact outcomes. In Phase I, the feasibility and acceptability of developing such a device was demonstrated. Phase II extends the Phase I efforts by expanding the product capability in Aim 1 to include an android version, customizable communication, 30 different bilingual communications with pre-programmed text and speech output, pain assessment capability using multiple pain scales, freestyle finger drawing, and integration with hospital based pagers, communication devices and nurse call systems. Aim 2 will demonstrate usability with iterative user assessment testing in a clinical setting. Aim 3 will test the clinical efficacy of VidaTalk vi android application with MV patients using a randomized control trial. If successful, VidaTalk will demonstrate notable reductions in anxiety, sedation exposure, delirium/coma-free days, and patient-reported frustration, communication difficulty and improved satisfaction with ICU care compared to MV patients receiving the standard of care. Furthermore, by delivering a solution that may positively impact patient outcomes, VidaTalk may also help standardize practice with respect to the provision and use of communication resources with MV patients.